Provider Demographics
NPI:1306417647
Name:IPAC, JUSTINE IBANEZ (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:IBANEZ
Last Name:IPAC
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9577 GONDOLIER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8286
Mailing Address - Country:US
Mailing Address - Phone:702-215-1627
Mailing Address - Fax:
Practice Address - Street 1:2839 SAINT ROSE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4849
Practice Address - Country:US
Practice Address - Phone:702-837-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2022-11-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant